The Impact of Performance and Appearance Pressures on Male Athletes: Part 2 of a Two Part Series

Our focus on the effect of sports on female athletes’ body image and eating has diverted our attention away from the challenges that face male athletes. On one hand, similarities exist to the pressures that face female athletes—namely in sports where aesthetics are important such gymnastics, diving, and figure skating and in sports where weigh ins are central or low weight or low body fat is believed to confer a competitive advantage such as wrestling, horse racing, ski jumping, rowing, distance running, and cycling. On the other hand, male athletes are also confronted with the hyper-masculine culture that permeates some sports including the pressure to “beef up” for sports in which high weights (and dense muscularity) are believed to convey a competitive advantage—most notably some positions in American football. These pressures can encourage unhealthy eating practices, obsessive focus on body fat percentage, and also the use of performance enhancing substances—all of which can have long term consequences for both physical and mental health.

A study conducted by Thiel and colleagues reported that more than 50% of male rowers and wrestlers engaged in some sort of binge eating compared with non-athlete controls and more than 10% met criteria for a subthreshold eating disorders. In high visibility revenue-generating sports, coaches, trainers, and owners can have a singular focus on performance and victory. Athletes’ bodies become a means to an end and the focus becomes the sport season rather than the full life course of the athlete. The impact of this myopic perspective is clearly visible in the devastating outcomes for athletes who have undergone traumatic brain injuries (TBI). UNC’s Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, under the directorship of Associate Dean Kevin Guskiewicz, PhD has played a seminal role in reducing TBIs in sport. Although less publicized, we see similarly debilitating long-term outcomes in athletes who have been “fed up” for their sports, who after retirement develop obesity, type 2 diabetes, and numerous joint-related problems for failing to have adequate oversight and assistance in adjusting their intake and activity after their competitive years come to an end.

Importantly, all male athletes do not experience long term adverse outcomes. In fact, on average, being an elite athlete tends to protect you from adverse health outcomes later in life—especially if you maintain an active lifestyle—but for those who do not, problems can compound.

Male athletes are also not exempt from the societal pressures to look a certain way. The frequency with which male professional athletes on Dancing With the Stars are encouraged to take off their shirts to reveal their underlying six-packs shows that appearance expectations continue long after retirement. Although increased regulation and monitoring of various performance enhancing drugs and steroids has helped to decrease reliance on these compounds, it is more difficult to monitor undetectable eating or weight loss techniques in male athletes.

We commonly say that eating disorders are more prevalent in females (with the exception of binge eating disorder which has a more balanced sex ratio), but we fail to recognize that all of those statistics are based on definitions of eating disorders that were built around the presentation of these illnesses in women. The more men and male athletes open up about their experiences with eating disorders, the more information we will have to refine our definitions of these illnesses in boys and men.

We are indebted to those men who do come forward with their stories. Joey Julius, a kicker for Penn State’s football team, has been very open on various social media outlets with his struggle with binge-eating disorder. Brian Cuban, author and advocate, (who visited UNC CEED in 2013) speaks openly about his turbulent transitions between binge eating and anorexia (manifested by over-exercising). Frank Bruni, former NYT food critic, NYT editorialist, and former Morehead-Cain scholar, (who also visited UNC CEED in 2010) discussed his transition out of competitive swimming and the trail of binge eating and purging that ensued. A culture of silence pervades male locker rooms that makes having an eating disorder supremely uncool and unmasculine. Taking a page from the Heads Together campaign in the UK championed by the Duke and Duchess of Cambridge and Prince Harry, if we don’t speak about mental illness, it will remain in the shadows. Their hashtag #oktosay has opened the conversation about mental illness and that freedom needs to extend to the locker room.

What can be done to change such an entrenched culture? The best first answer is to improve psychoeducation for coaches, trainers, and athletes. Spreading awareness and providing concrete tools for detecting and approaching an athlete with your concerns about his health are important first steps. Balancing the pressure for wins with caring for the health and well-being of an athlete becomes increasingly complicated as millions of dollars are on the line. But, addressing these issues does not automatically mean removal from athletic participation. In fact, addressing them can improve performance! Most importantly, we need to spread the word widely that eating disorders don’t care if you are male or female. They are equal opportunity illnesses that might look somewhat different in women and in men. Even the language that we use to describe them may differ by sex. Deeper understanding of sex differences in eating disorders—both on and off the playing field—are critical areas in need of greater scientific attention.